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Transcript of Gait Assessment ofGait Assessment of Neurologgy … Timple.pdf · Gait Assessment ofGait Assessment...
Gait Assessment ofGait Assessment of Neurologically Challenged g y gPatients
Cathelyn Timple, PT, DPT, NCS, ATPCasa Colina Centers for Rehabilitation
ObjectivesObjectivesUnderstand normal gait mechanics and terminologyUnderstand normal gait mechanics and terminology
Recognize pathological gait patterns commonly associated with visual and vestibular deficits in neurologically challenged g y gpatients.
Administer the Functional Gait Assessment and the 10-Meter W lk T tWalk Test
Normal GaitNormal Gait“repetitious sequence of limb motion to move the body forward while simultaneously maintaining stance stabilitystability
Observational Gait AnalysisGait Analysis
•Qualitative visual description •Qualitative visual description of an individual’s upper and lower extremities, pelvis and
k dtrunk motions during ambulation.
Normal Human GaitNormal Human Gait
StrideStride
StanceStance
Weight AcceptanceWeight Acceptance Single Limb Support
Single Limb Support
SwingSwing
AdvancementLimbAdvancementLimb
Initial ContactInitial Contact Loading ResponseLoading Response
SupportSupport
Mid StanceMid Stance Terminal StanceTerminal Stance PreSwingPreSwing Initial SwingInitial Swing Mid SwingMid Swing Terminal SwingTerminal Swing
Normal Human GaitNormal Human Gait
STANCE: 62% SWING 38%
IC LR MSt TSt PSw ISw MSw TSw
Weight Single Limb Swing Limb AdvancementAcceptance Support
Stance PhaseStance Phase
Initial Contact (IC) The moment when the foot Initial Contact (IC): The moment when the foot contacts the ground
Stance PhaseStance Phase
Loading Response (LR) Weight is rapidly transferred Loading Response (LR): Weight is rapidly transferred onto the outstretched limb, the first period of double-limb support
Stance PhaseStance Phase
Mid Stance (MSt): The body progresses over a single Mid-Stance (MSt): The body progresses over a single, stable limb.
Stance PhaseStance Phase
Terminal Stance (TSt): Progression over the stance Terminal Stance (TSt): Progression over the stance limb continues. The body moves ahead of the limb and weight is transferred onto the forefoot.
Stance PhaseStance Phase
Pre Swing (PSw): A rapid unloading of the limb Pre-Swing (PSw): A rapid unloading of the limb occurs as weight is transferred to the contralateral limb.
Swing PhaseSwing Phase
Initial Swing (ISw): The thigh begins to advance as Initial Swing (ISw): The thigh begins to advance as the foot comes up off the floor.
Swing PhaseSwing Phase
Mid Swing (MSw): The thigh continues to advance as Mid-Swing (MSw): The thigh continues to advance as the foot comes up off the floor.
Swing PhaseSwing Phase
Terminal Swing (TSw): The knee extends the limb Terminal Swing (TSw): The knee extends; the limb prepares to contact the ground for Initial Contact.
Pathological Gait AnalysisAnalysis
Common Descriptive Terms for pAbnormal Gait
Antalgic HikingAntalgic
Ataxic
Hiking
Trendelenberg
Athetoid
Festinating
Toe Drag
Vaulting
Scissoring
Shuffling
Unstable
Extensor syngeryShuffling
Steppage
Extensor syngery
Flexor syngery
Qualitative Gait Analysis Form
Quantitative Gait Analysis
Functional Gait AssessmentFunctional Gait Assessment
Standardized test for assessing postural instability Standardized test for assessing postural instability during various walking tasks
10 item gait assessment based on the Dynamic Gait 10- item gait assessment based on the Dynamic Gait Index
Equipment Stop atch marked alking area shoe bo Equipment: Stopwatch, marked walking area, shoe box for obstacle, set of steps
S i g 0 f i i t t 3 f l Scoring: 0 for severe impairment to 3 for normal performance; maximum score possible is 30.
Functional Gait AssessmentFunctional Gait Assessment
Step over ObstacleGait Level Surface Step over Obstacle
Gait with Narrow Base of Support
Gait Level Surface
Change in Gait Speedpp
Gait with Eyes Closed
A b l B k d
Gait with Horizontal Head Turns
G h V l H d Ambulation Backwards
Steps
Gait with Vertical Head Turns
G it d Pi t TGait and Pivot Turn
Functional Gait AssessmentReference Group Data
Age N Min Max Mean SD CIAge N Min Score
Max Score
Mean SD CI
40-49 27 24 30 28.9 1.5 28.2-29.5
50 59 33 25 30 28 4 1 6 27 9 29 050-59 33 25 30 28.4 1.6 27.9-29.0
60-69 63 20 30 27.1 2.3 26.5-27.7
70-79 44 16 30 24.9 3.6 23.9-26.0
80-89 33 10 28 20.8 4.7 19.2-22.6
TOTAL 20 10 30 26.1 4.0 25.5-26.6
10-Meter Walk Test10-Meter Walk Test
Examines gait speedExamines gait speed
To administer test:M 10 d k d i h Measure a 10 meter course and mark ends with tape
Position subject 3 feet behind tape
Instruct the subject to walk at a comfortable rate until Instruct the subject to walk at a comfortable rate until he is 3 feet past the time line
Repeat up to 3 times and average the times
h b lk b b fInstruct the subject to walk as above , but as fast as possible
Repeat up to 3 times and average the timesp p g
10-Meter Walk Test10-Meter Walk Test
Comfortable (m/min) Maximum (m/min)
Gender/Decad
Men Women Men Womende
20s 83.6 84.4 151.9 148.0
30s 87.5 84.9 147.4 140.5
40s 88.1 83.5 147.7 127.4
50s 83.6 83.7 124.1 120.6
60s 81.5 77.8 115.9 106.460s 81.5 77.8 115.9 106.4
70s 79.5 76.3 124.7 104.9
CASE STUDY CASE STUDY
QUESTIONS????QUESTIONS????
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H lb d JL V ijk B H b K Sl ld O Al d i i d bili i i ld G i & P 30(2009) 233 238Helbostad JL, Vereijken B, Hesseberg K, Sletvold O. Altered vision destabilizes gait in older persons. Gait & Posture 30(2009) 233-238.
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